Medicalization of Birth: The Social Construction of Cesarean Section. A Qualitative Analysis.

Abstract

The Cesarean birth rate in the United States is nearly 32%, among the highest in the world. Yet, there has not been a comparable decrease in infant mortality.This study compares the cesarean experiences of middle class women with the experiences of poorer women. In-depth, face to face interviews were done with 32 low risk women who had cesareans about six weeks earlier. The women in this study asked for cesarean only when they believed vaginal birth would cause serious harm to them or their babies, or after their attempts at vaginal delivery failed. Doctors tended to resist women’s requests for cesarean. Some women were told that they “could die from cesarean section”. Women who agreed to cesarean sections typically did not understand the seriousness of the surgery and assumed that cesarean section would be quicker and less painful than vaginal delivery. Most women who wanted to avoid cesarean were able to do so when their babies were not in distress. Women used a variety of creative strategies and some were willing to endure severe pain to avoid cesarean section. Husbands or boyfriends may or may not behave in ways that are supportive. Women who had a doctor who supported vaginal birth after cesarean or who were able to negotiate with doctors around cesarean were better able to achieve their goal of vaginal delivery. Perhaps no form of obstetrical care has been as debated as cesarean section, but the debates exclude those who are most affected by the problem—the women themselves. This dissertation has been an attempt to give voice to these women. Their experiences suggest a need for developing and using alternatives to the medicalized model.